Operative treatment of bilateral hip dislocation in children with arthrogryposis multiplex congenita

Abstract PURPOSE: Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. It is commonly believed that bilaterally dislocated hips associated with joint contractures should not be reduced, because movement is satisfactory, while open reduction leads to poor results. This report presents our experience with surgical management of bilateral dislocation of hips in children with AMC. METHODS: During the period 1990 to 2000, we performed open reduction on 8 hips of 4 children with AMC. The mean age at surgery was 23 months (range, 5-48 months). Open reduction and capsular plication without any bony procedure were performed in 4 hips (2 patients). De-rotation and varus osteotomy of the femur was performed in 4 hips, and Salter osteotomy of the innominate bone in 2 hips. The average acetabular index was 44 degrees, and the mean centreedge angle was -41 degrees preoperatively. RESULTS: The average follow-up period was 4 years (range, 2-9 years). The average acetabular index and centre-edge angle were 19 and 18 degrees, respectively at the time of last follow-up. All children could walk without support. One child required re-opening for redislocation of hip joint. The clinical results were good in 6 hips and fair in 2 hips, according to Severin\u27s and McKay\u27s classifications. CONCLUSION: Our experience shows that open reduction for bilateral dislocation of hips in children with AMC is a suitable option with generally good results. Surgery performed at earlier age gives the best functional outcome

Comparsion of Topical Corticosteroid Nasal Spray / Second Generation Antihistamine with Topical Corticosteroid Nasal Spray

Objective: To compare the effectiveness of topical nasal corticosteroids alone and in combination with second generation oral antihistamine in the treatment of moderate to severe allergic rhinitis.Study design: Randomized control trialDuration of study: One year from 15th June 2011 to 15th June 2012, E.N.T outpatient department Fauji foundation hospital Rawalpindi.Methodology: 200 cases meeting the inclusion and exclusion criteria were taken from the outpatient E.N.T Department Fauji Foundation Hospital Rawalpindi and informed consent was taken from each of them for using their data in this study. My study variables are age, gender, the effectiveness of treatment given to each of the two groups, rhinorrhoea, sneezing, nasal blocking, nasal itching, post nasal drip and condition of nasal mucosa. Nasal speculum is used to examine the nose with the head light and post nasal drip is seen with the help of tongue depressor. There were 200 patients divided into two groups of 100 patients each. Group I treated with topical nasal corticosteroid spray (flunisolide) and group II receiving second generation oral antihistamine tablet (loratadine) in addition to the topical nasal corticosteroid (flunisolide). Results: 200 patients were included in the study from E.N.T outpatient department in Fauji foundation hospital Rawalpindi. On the basis of treatments, intranasal corticosteroid spray (INCS) alone and in combination with second generation oral antihistamine patients were divided into two groups of 100 patients in each group and evaluated for effectiveness of each treatment. Effectiveness was assessed by improvement score in symptoms for both the types of treatments to see which treatment of the two was more effective. Conclusion: The comparative study of Intranasal corticosteroids spray alone and in combination with second-generation antihistamines proved that combination treatment of INCS with antihistamine is better therapy than intranasal corticosteroid spray alone in allergic rhinitis

Impact of Financial Risk on Financial Performance of Banks in Pakistan; the Mediating Role of Capital Adequacy Ratio

Financial risks, cover credit, liquidity and operational risks, are the risks which banks face during their operations and all these risks have severe impact on the profitability of banks. The Basel Committee for Banking Supervision (BCBS) introduces Capital Adequacy Ratio (CAR) to overcome uncertainties and possible losses (Risk) to the banks. In this context, the aim in this study is to identify impact of financial risk on financial performance of banks in Pakistan with mediating role of Capital Adequacy Ratio (CAR). The findings show that credit and liquidity risks have negative relationship with financial performance, whereas operational risk has a positive relationship with financial performance and capital adequacy ratio of banks in Pakistan. This study is useful in devising the rules and regulations by the regulators (Basel Committee and State Bank of Pakistan) for risk measurement and management by the banking sector.&nbsp

Thermal analysis and efficiency enhancement of solar modified PV panels through organic PCM under climate conditions of Pakistan

Passive cooling of photovoltaics (PV) using phase change materials (PCM) may be extremely effective owing to their enormous implicit specific heat. However, the low rate of heat transfer, high solar radiation, and ambient temperature drop its efficiency by 0.45%/ᵒC. Only such a small fraction of solar irradiance is turned into electrical energy by PV cells; most of the irradiation is transformed into heat; hence, cells start operating above ambient temperature. Therefore, the exterior heat of photovoltaic panels is controlled by applying artificial cooling to enhance their efficiency. The current research aims on the significant benefits of using PCM to reduce panel surface temperature in terms of boosting energy efficiency and maintaining thermal comfort. This study demonstrates a successful design of PV controlled-temperature module using phase change materials for hot climate, especially for south Asian regions. The surface temperature of solar panels has been reduced using computational analysis and experimental study on paraffin wax. In this work, Paraffin wax used, which reduced the panel surface temperature by 5-7ᵒC, generating a 29% increase of the modified PV panel relative efficiency compared to its standard value

IMPACT OF RESEARCH & DEVELOPMENT ON THE PERFORMANCE OF PHARMACEUTICAL FIRMS: EVEDENCE FROM PAKISTAN

The goal of this study is to investigate the financial performance of listed Pharmaceuticalcompanies in Pakistan impacted by different board characteristics. These board characteristics are discussedthrough two theories: agency theory and resource dependency. The understudy characteristics include research& development, independent board directors, leverage, CEO/Chair duality, board size and audit committee. Thepaper used panel regression analysis on 11 firms from period of 2010 to 2019. It was found that investment inresearch & development and audit committee have significant and positive impact on the performance of firmsas per agency theory. Whereas the characteristics like Independent directors, CEO duality, leverage and boardsize had negative impact on the performance of the firms. The study helps to clarify the Board's performancerelationship and offers academic proof of existing and future governance changes for policy makers in Pakistan.The conclusions add to the literature by presenting fresh and original perspectives into how the existingknowledge of corporate governance and financial performance is applied within a developing context ofPakistan

Acetabular morphometry and prevalence of hip dysplasia in the South Asian population

We carried out a cross-sectional study to measure the association of the seven acetabular parameters with pelvic morphometry and prevalence of hip dysplasia in our population. Convenience sampling was carried out and 250 consecutive patients who came to AKUH for intravenous pyelogram and had no complaints in the region of the hip joint were enrolled in the study. Post-micturition standardized plain antero-posterior pelvic radiographs of 250 asymptomatic adults (500 hip joints) was studied. There were 136 males (54.4%) and 114 females (45.6%). Mean age of our study population was 38 years (15-78 years). The average center edge angle was 35.5±6.6° standard deviation (SD), acetabular angle was 37.76±4.37°, depth to width ratio was 0.31±4.6°, roof obliquity was 10.6±6.2°, extrusion index was 0.1±5.8, lateral subluxation 8.9±2.7 mm, and peak to edge distance 17±3.98 mm. There was significant influence (p\u3c0.05) of age in all angles except depth to width ratio. A total of seven hip joints (1.4%) were dysplastic with CE angle \u3c25° while four of the seven hips were severely dysplastic with CE angle \u3c20°. In the dysplastic group there was significant correlation (p\u3c0.05) of CE angle with acetabular angle, depth to width ratio, extrusion index and peak to edge distance. Prevalence of hip dysplasia was found to be very low in our population. These results are consistent with the findings of studies carried out in other Asian countries

Pre-operative Anxiety Compounding Intra-operative Hypotension in Parturient women undergoing Cesarean Deliveries under Spinal Anesthesia

OBJECTIVE: To assess the relation of intra-operative hypotension with severity of pre-operative anxiety in patients undergoing caesarean section under spinal anesthesia. STUDY DESIGN: Prospective observational study. PLACE AND DURATION OF STUDY:  This study was carried out from June 2017 to May 2018 at anesthesia department of Combined Military Hospital Lahore. METHODOLOGY: One hundred and twenty patients belonging to America Society of Anesthesiology class I and II, undergoing caesarean section under spinal anesthesia were selected.  Verbal Analogue Scale for anxiety (VASA) and Straight Trait Anxiety Inventory (STAIs) questionnaire were used to measure pre-operative anxiety. Patients were divided into three groups as mild (VASA<3or STAIs<44), moderate (VASA 4-7 or STAIs 44-55) and severe (VASA 7-10 or STAIs>55) anxiety. Baseline mean arterial pressure was measured. Patients were placed in supine position immediately after induction of spinal anesthesia at L3-L4 or L4-L5 level with 12mg bupivacaine. Blood pressure was measured every two minutes until the delivery of baby. Hypotension was labeled when mean arterial pressure dropped by 20% below the baseline. The effect of level of anxiety on drop in MAP was assessed. RESULTS: Seventeen (14.17%) patients had mild pre-operative anxiety; out of which four (23.53%) developed hypotension. Seventy three (60.83%) patients had moderate anxiety; out of which twenty seven (36.99%) developed hypotension. Thirty (25%) patients had severe anxiety; out of which twenty two (73.33 %) developed hypotension. P-value (0.001) was quite significant. CONCLUSION:  It was concluded in our study that severity of pre-operative anxiety has significant effect on intra-operative spinal hypotension

FAMILY ACANTHACEAE AND GENUS APHELANDRA: ETHNOPHARMACOLOGICAL AND PHYTOCHEMICAL REVIEW

Aphelandra belong to family Acanthaceae. We have reviewed traditional uses, pharmacological potential and phytochemical study of family Acanthaceae and genus Aphelandra. Traditionally the most important part use in Acanthaceae is the leaves and they are used externally for wounds. We have found that Acanthaceae possess antifungal, cytotoxic, anti-inflammatory, anti-pyretic, anti-oxidant, insecticidal, hepatoprotective, immunomodulatory, Anti- platelet aggregation and anti-viral potential. Phytochemical reports on family Acanthaceae are glycosides, flavonoids, benzonoids, phenolic compounds, naphthoquinone and triterpenoids. We have also document genus Aphelandra, its phytochemical and pharmacological potential